A five-year retrospective review of fatalities involving novel psychoactive substances in Southern Ireland

Andrew Mazurek; Margot Bolster

doi:10.33178/SMJ.2023.1.1

Authors

Andrew Mazurek
Margot Bolster

DOI:

https://doi.org/10.33178/SMJ.2023.1.1

Keywords:

novel psychoactive substances, substance use, fatality

Abstract

Introduction: Novel psychoactive substances (NPS) are rapidly emerging and being reformulated to evade legislative controls, creating unpredictability in drug markets and ineffective drug policies. Given that Ireland has the highest self-reported NPS use within Europe and literature regarding health risks is lacking, the National Advisory Committee on Drugs has advocated for the surveillance of regional trends.

Objectives: To elucidate the demographic and autopsy findings of fatal cases involving NPS in Southern Ireland as compared to deaths involving traditional drugs of abuse (TDOA).

Methods: Post-mortem reports from the Cork-Kerry region with positive toxicology for illicit substances between 2012-2016 were retrospectively analyzed to compare NPS and TDOA cases with respect to circumstances surrounding death, toxicological results, and pathological findings.

Results: Between 2012-2016, there were 164 cases involving illicit substances in the Cork-Kerry region. NPS accounted for 17 (10.4%) cases, with an average annual mortality rate of 34.8 per 100,000 population. NPS contributed to the cause of death in 70.6% of cases where detected, compared to 43.5% for TDOA only. In both cohorts, fatal abusers were predominantly young males. Importantly, cases involving NPS showed a higher proportion of mono-drug intoxication and presentation to hospital prior to death. Autopsy findings were non-specific but commonly featured pulmonary congestion, aspiration, and cerebral oedema.

Conclusion: NPS are detected in a small proportion of medicolegal autopsies but contribute significantly to acute intoxication deaths. This study highlights the need for effective drug monitoring and enforcement strategies, along with improved management of drug toxicities presenting to hospital.

References

O’Neill C. Novel psychoactive substances: risks and harms. Community Pract. 2014 Aug;87(8):45-7.

The European Monitoring Centre for Drugs and Drug Addiction. European Drug Report: Trends and Developments. Luxembourg: Publications Office of the European Union, 2021.

Dines AM, Wood DM, Yates C, et al. Acute recreational drug and new psychoactive substance toxicity in Europe: 12 months data collection from the European Drug Emergencies Network (Euro-DEN). Clin Toxicol. 2015 Oct;53(9):893-900.

Hondebrink L, Nugteren-van Lonkhuyzen JJ, Van Der Gouwe D, Brunt TM. Monitoring new psychoactive substances (NPS) in The Netherlands: data from the drug market and the Poisons Information Centre. Drug Alcohol Depend. 2015 Feb;147:109-15.

Kamijo Y, Takai M, Fujita Y, Sakamoto T. A multicenter retrospective survey of poisoning after consumption of products containing novel psychoactive substances from 2013 to 2014 in Japan. Am J Drug Alcohol Abuse. 2016 Sep;42(5):513-9.

Murray DB, Potts S, Haxton C, Jackson G, Sandilands EA, Ramsey J, et al. ‘Ivory wave’ toxicity in recreational drug users; integration of clinical and poisons information services to manage legal high poisoning. Clin Toxicol. 2012 Feb;50(2):108-13.

Mazurek A, Bolster M. Trends in Novel Psychoactive Substance Use and the Impact of Irish Legislative Efforts. UCC Student Medical Journal. 2020 Oct;1:55-63.

Ezaki J, Ro A, Hasegawa M, Kibayashi K. Fatal overdose from synthetic cannabinoids and cathinones in Japan: demographics and autopsy findings. Am J Drug Alcohol Abuse. 2016 Sep;42(5):520-9.

Van Hout MC. The Dynamic Landscape of Novel Psychoactive Substance (NPS) Use in Ireland: Results from an Expert Consultation. Int J Ment Health Addiction. 2017 Oct;15(5):985-92.

Ryall G, Butler S. The great Irish head shop controversy. Drugs: Educ Prev Polic. 2011 Aug;18(4):303-11.

Van Hout MC, Brennan R. Curiosity killed M-Cat: A post-legislative study on mephedrone use in Ireland. Drugs: Educ Prev Pol. 2012;19(2):156-62.

Pergolizzi JV, LeQuang JA, Taylor R, Raffa RB. The “Darknet”: The new street for street drugs. J Clin Pharm Ther. 2017 Dec;42(6):790-2.

Smyth BP, James P, Cullen W, Darker C. “So prohibition can work?” Changes in use of novel psychoactive substances among adolescents attending a drug and alcohol treatment service following a legislative ban. Int J Drug Policy. 2015 Sep;26(9):887-9.

Loeffler G, Craig C. The effect of legal bans on poison control center contacts regarding ‘legal highs’. Addiction. 2013 Jul;108(7):1348-9.

Van Hout MC, Bingham T. “A costly turn on”: patterns of use and perceived consequences of mephedrone based head shop products amongst Irish injectors. Int J Drug Policy. 2012 May;23(3):188-97.

The Gallup Organization. Youth attitudes on drugs. Luxembourg: European Commission, 2011.

European Monitoring Centre for Drugs and Drug Addiction. Ireland: Country Drug Report 2017. Luxembourg: Publications Office of the European Union, 2017.

Kelleher C, Christie R, Lalor K, Fox J, Bowden M, O’Donnell C. An overview of new psychoactive substances and the outlets supplying them. Dublin: National Advisory Committee on Drugs, 2011.

Health Service Executive. CHO Report Chapter 1: Executive Summary. Dublin, Ireland: Community Healthcare Services, 2013.

The European Monitoring Centre for Drugs and Drug Addiction. Early Warning System on NPS. Lisbon, Portugal:European Union, 2019.

Markovic M, Kocovski L, Fernandes JR. Retrospective analysis of oxycodone- and cocaine-related deaths in Southwestern Ontario during 2003-2010. Acad Forensic Pathol. 2014;4(2):220-5.

StatBank. Population at Each Census from 1841 to 2016 by County, Sex and Census Year. Cork, Ireland: Central Statistics Office, 2018.

European Monitoring Centre for Drugs and Drug Addiction. Fentanils and synthetic cannabinoids: driving greater complexity into the drug situation. Luxembourg: Publications Office of the European Union, 2018.

White JM, Irvine RJ. Mechanisms of fatal opioid overdose. Addiction 1999;94:961-72.

National Drug-Related Deaths Index. Drug-related deaths and deaths among drug users in Ireland. Dublin: Health Research Board, 2015.

Backmund M, Meyer K, Meyer K, et al. Co-consumption of benzodiazepines in heroin users, methadone-substituted and codeine-substituted patients. J Addict Dis. 2006;24(4):17-29.

Hickman M, Carrivick S, Paterson S. London audit of drug-related overdose deaths: characteristics and typology, and implications for prevention and monitoring. Addiction 2006;102:317-23.

European Monitoring Centre for Drugs and Drug Addiction. Ireland: Country Drug Report 2019. Luxembourg: Publications Office of the European Union, 2019.

European Monitoring Centre for Drugs and Drug Addiction. ESPAD Report 2015: Results from the European School Survey Project on Alcohol and Other Drugs. Luxembourg: Publications Office of the European Union, 2015.

Ezaki J, Ro A, Hasegawa M, Kibayashi K. Fatal overdose from synthetic cannabinoids and cathinones in Japan: demographics and autopsy findings. Am J Drug Alcohol Abuse 2016;42(5):520-9.

Marinetti LJ, Antonides HM. Analysis of synthetic cathinones commonly found in bath salts in human performance and postmortem toxicology: method development, drug distribution and interpretation of results. J Anal Toxicol. 2013;37:135-46.